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Central Line Maintenance

Central Line Maintenance

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Central Line Maintenance

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  1. Central Line Maintenance

  2. Learning Objectives • Review the evidence and recommendations for central line maintenance

  3. Source of Recommendations • Centers for Disease Control • Society for Healthcare Epidemiology of America • Infectious Diseases Society of America

  4. Overview of Recommendations Central line maintenance recommendations address the following topics: • Central line insertion • Central line dressing changes • Replacement of IV administration sets • Hang time for parenteral fluids • Catheter hub cleansing • Removal of unnecessary lines • Education

  5. Central Line Insertion • Ensure use of checklist • Empower nurses to stop the procedure if the steps in the checklist are not followed • Leadership must create a culture that supports nurses

  6. Central Line Dressing Change Dressing change responsibility includes only those who have demonstrated competency: • Nursing personnel including PICC teams and nurse practitioners • Medical personnel including physicians and physician assistants

  7. Central Line Dressing Change Frequency: • Transparent dressing • Every 7 days • PRN if damp, loosened, or soiled • Gauze dressing • Every 48 hours for routine use

  8. Replacement of IV Administration Sets • Lipids and blood products (enhance bacterial growth) • Change every 24 hours • All other IV administration sets • No more frequently than every 72 hours • Not more than every 96 hours

  9. Hang Time for Parenteral Fluids • Lipid-containing parenteral nutrition • Change every 24 hours • All other IV fluids including nonlipid-containing parenteral nutrition • No formal recommendations • JHH changes nonlipid-containing IV fluids every 24 hours

  10. Catheter Hub Cleansing • Clean hub before accessing with Chlorhexidine or 70% alcohol • No formal recommendations regarding how long to cleanse hub

  11. Remove Unnecessary Lines • Assess need for continued central line access during daily multidisciplinary rounds • Add question to a Daily Goals worksheet • Complete every day during rounds

  12. Education Educate all necessary staff: • Guidelines to prevent catheter-related bloodstream infections • Use of central line checklist • Proper insertion and maintenance of central lines Ensure competency through yearly education and examination

  13. References • Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology. 2008; 29 (supp. 1):S22-S30. • O’Grady NP, Alexander M, Dellinger P, et al. Guidelines for the prevention of intravascular catheter-related infections. Infection Control and Hospital Epidemiology. 2002; 23(12):759-769.